28 KBVIEW — TUOPICAL MEDICINE, ETC. 



Cerebro- Steven,' in an interesting lectm-e, deals with the differential diagnosis, mentions a 



Spinal Fever case where faecal poisoning was mistaken for a case of cerebro-spinal meningitis, and refers 

 —continued to an Egyptian case of vei'minous infection closely simulating the fever. 



Nedwiir- records two epidemics in the Sudan occurring in the summer of 1005 and 1906, 

 during the months, be it noted, when the dust storms occur. From a study of 22 cases he 

 concludes that non-recovery of the knee jerks within a week of the onset of the disease is an 

 unfavourable sign. The mortality was roughly 59 per cent. 



Cases of remarkable cure after the use of collargol are reported." It is employed as an 

 injection into the spinal canal, doses mentioned being 0-05 gramme and 5 c.c. of a 1 percent, 

 solution. 



The claims of Weichselbauni's meningococcus to be the cause of the disease have been 

 amply confirmed by recent work to which there is no need to allude, but mention may be 

 made of the bacillary form which this organism may assume when cultivated. A note on 

 this will be found in a paper by Darling and Wilson'' who from their work conclude that the 

 Meningeal diplococcus belongs to the Streptococcus fsecalis group, and is identical with the 

 Micrococcus rheunialicus. 



The latter author' in a later paper states that all the Gram-negative cocci met with by 

 him and his co-workers iu cases of cerebro-spinal meningitis failed to grow on the 

 Drigalski-Conradi medium. To this rule he found three exceptions, and the diplococci from 

 these cases not only grew well on this medium, but, instead of tending to take on a 

 bacillary form as is usual, retained their diplococcal characters on the Drigalski-Conradi 

 medium, although they tended to assume the bacterial form on agar. " We conclude then," 

 he says, " that in the lumbar puncture fluid of certain cases of cerebro-spinal meningitis 

 Gram-negative diplococci may be found which differ from Weichselbaum's and Still's cocci 

 in respect of their morphology and capacity for growth on the Drigalski-Conradi medium. 

 It may be that certain abnormal appearances presented by meningococci, such as growth in 

 short chains which competent observers claim to have seen, may have been due to the 

 presence of this coccus in the cultures." 



The opsonic power of the serum has been the subject of research by various workers, 

 and Houston and Eankine'' tabulate the results of their examinations, finding that the 

 opsonic index seems to be a more delicate test of infection than the agglutination reaction, 

 and that the two tests combined will prove of great value in diagnosis. Levy'* records a 

 remarkable series of cures by means of Kolle-Wassermann's serum injected intra-spinally. 

 The dose for children over one year was 20 c.c, for adults 30 to 40 c.c. Of 23 cases treated 

 with the serum, only 5 died, and of these 3 had too small a dose or received the dose 

 subcutaneously. Of 17 cases properly treated, only 2 died. A preliminary injection of 

 morphine is given, then the serum, and the patients are kept for eight to twelve hours with 

 their pelves raised. Robb** speaks favourably of Flexner and Jobling's serum, but does not 

 commit himself to a definite opinion as to its merits. Trautmanu and Fromme''* record the 

 results of work done in the Hygienic Institute in Hamburg during 1907. Thirty-two 

 specimens were examined from patients and 312 from contacts. In only 9-2 per cent, of 

 the latter was Weichselbaum's meningococcus isolated. One "germ-carrier" case remained 

 infective for 66 days. In subcultures on Loeffler's serum a typical growth was common, 



' Steven, J. L. (September 8th, 1906), "Epidemic Cerebro-Spin.il Fever, with Illustrative Cases." Lancet, 

 p. 638, Vol. II. 



2 Nedwill, C. L. (December 1st, 1906), " Cerebro-Spinal Meningitis in the Sudan." Lnncet, p. 1502, Vol. II. 



' January 12th, 1907, " Recovery from Cerebro-Spinal Meningitis under Injections of Collargol in the Spinal 

 Canal." Lancet, p. 106, Vol. I. 



" Darling, J. S., and Wilson, W. J. (February 23rd, 1907), "A Case of Cerebro-Spinal Meningitis." Dritish 

 Medical Journal, p. 433, Vol. I. 



^ Wilson, W. J. (June 20th, 1908), " DifEercntiation of certain Gram-negative Cocci occurring in Cases of 

 Cerebro-Spinal Meningitis by their Morphology and Power of Growth on the Drigalski-Conr.adi Medium." 

 Lancet, Vol. I. 



'^ Houston, T., and Rankine, J. C. (May 4th, 1907), "A Note on the Opsonic Power of the Serum, with 

 Reference to the Meningococcus of Cerebro-Spinal Fever occurring in the Belfast Epidemic." Lancet, p. 1213, Vol. I. 



' Levy, Q. Deutsche Med. Wochen., 1908, No. 4, p. 139. 



' Robb, A. G. (February 15th, 1908), "The Treatment of Epidemic Cerebro-Spin.al Fever by Intra-spinal 

 Injections of Flexner and Jobling's Anti-meningitis Serum." British Medical Journal, p. 382. 



» Trautmaun, H., and Fromme, W. (1908). Munch. Med. IVochcnschr., No. 15. 



• Article not consulted in the original. 



